ISLAMABAD: As the cases of cholera are on the rise in Sindh, Balochistan and Punjab, the World Health Organisation (WHO) has warned that the risk of its potential international spread from Sindh exists given that most affected districts are located in Karachi which is an industrial centre as well as transport hub with airport and seaport.

Currently, there is no evidence of cross-border spread of the disease. However, the risk of potential international spread exists given that Pakistan has long land borders with significant cross-border movement and multiple major urban hubs, including Karachi city, with international transport hubs, WHO says in its advisory which was made available on Monday.

In Balochistan, there is sub-optimal surveillance, limited access to safe drinking water, and limited access to health care, and affected areas are in proximity to regions with active cross-border movement with Afghanistan and Iran.

In Punjab, although response activities are taking place, the province is still recording an increased number of suspected cholera cases, including in Lahore, the provincial capital and a large international commercial hub. Further spread to other provinces would worsen the situation given the frequent population movement.

Necessary control measures are being implemented by the national authorities with support from WHO and partners to contain the outbreak. However, there is a need to further strengthen surveillance by establishing systematic detection and laboratory confirmation of cholera to properly track the evolution of the outbreak and institute timely and appropriate interventions.

WHO has advised the government to strengthen the disease surveillance system in the country. Surveillance for early case detection, confirmation, and response should be reinforced, according to the latest advisory.

As of May 27, three provinces — Sindh, Balochistan, and Punjab — have reported a total of 290 confirmed cases of cholera. A total of 109 samples have been tested from the public water sources (hydrants) and individual households in Karachi city as of May 27.

Among these, results are available for 71 samples, of which 70 per cent have shown presence of Vibrio cholera while Escherichia Coli and coliform was detected in 55 per cent and 90 per cent of samples, respectively.

In addition to Sindh province, three districts in Balochistan have reported 31 confirmed cases and nine deaths while two districts in Punjab have reported 25 confirmed cases.

WHO says cholera is an acute enteric infection caused by ingesting the bacteria Vibrio cholera present in contaminated water or food. It is mainly linked to insufficient access to safe drinking water and inadequate sanitation.

It is an extremely virulent disease that can cause severe acute watery diarrhoea resulting in high morbidity and mortality, and can spread rapidly, depending on the frequency of exposure, the exposed population and the setting. Cholera affects both children and adults and can be fatal if untreated.

Published in Dawn, June 21st, 2022